Ikeda Shigemasa
Department of Anesthesiology and Critical Care, St. Louis University School of Medicine, St. Louis, MO 63141.
J Anesth Hist. 2020 Jun;6(2):79-83. doi: 10.1016/j.janh.2019.07.001. Epub 2019 Oct 15.
Methoxyflurane was an inhaled agent commonly used for general anesthesia in the 1960s, but its clinical role gradually decreased in the 1970s because of reports of dose-dependent nephrotoxicity. In 1999 its manufacturer, Abbott Laboratories, discontinued distribution of methoxyflurane in the United States and Canada. Outside of North America, however, methoxyflurane has been reborn as an inhaled analgesic used for pain relief in the prehospital setting and for minor surgical procedures. First used in Australia and New Zealand, and subsequently in over thirty-seven other countries, low concentrations of methoxyflurane are administered with a hand-held inhaler which provides conscious sedation, so that patients can self-assess their level of pain and control the amount of inhaled agent. The Penthrox inhaler, originally developed in Australia after several other hand-held vaporizers were tried, is currently being used worldwide as a portable and disposable self-administered agent delivery system. Methoxyflurane-induced nephrotoxicity continues to be a major concern, but with cautious administration of recommended doses methoxyflurane has been established as a remarkably safe analgesic agent with minimal side effects for patients in need of rapid and potent pain relief.
甲氧氟烷是20世纪60年代常用的一种吸入性麻醉剂，但由于有剂量依赖性肾毒性的报道，其临床应用在20世纪70年代逐渐减少。1999年，其制造商雅培实验室停止在美国和加拿大销售甲氧氟烷。然而，在北美以外地区，甲氧氟烷已重获新生，成为一种用于院前疼痛缓解和小型外科手术的吸入性镇痛药。低浓度的甲氧氟烷最初在澳大利亚和新西兰使用，随后在其他三十七个以上的国家使用，通过手持式吸入器给药，可提供清醒镇静，使患者能够自我评估疼痛程度并控制吸入剂的用量。在试用了其他几种手持式蒸发器后，最初在澳大利亚开发的Penthrox吸入器目前在全球范围内用作便携式一次性自我给药的药剂输送系统。甲氧氟烷引起的肾毒性仍然是一个主要问题，但通过谨慎使用推荐剂量，甲氧氟烷已被确立为一种非常安全的镇痛药，对需要快速强效缓解疼痛的患者副作用极小。
